Surgical treatment of early-stage breast cancer in the Department of Defense Healthcare System

BACKGROUND: The choice between breast-conserving surgery and modified radic al mastectomy in the treatment of women with early stage breast cancer in t he Department of Defense Healthcare System may be influenced by demographic factors. STUDY DESIGN: The Department of Defense Automated Central Tumor Registry (A CTUR) was queried for women diagnosed with American Joint Committee on Canc er Stage I or II invasive breast carcinoma from January 1, 1986, to Decembe r 31, 1996. Univariate analysis and multivariate analysis were applied to t he study variables. Year of diagnosis, age at diagnosis, tumor size, type o f hospital, geographic region, and local availability of radiation therapy were evaluated with respect to the type of surgical treatment performed. Su rgical treatment was either breast conservation therapy (BCT) or modified r adical mastectomy. RESULTS: After excluding women for whom the data were incomplete (n = 308), 7,815 women were identified who met study criteria. There was a progressiv e increase in the use of BCT to treat tumors of all sizes from 16% to 47% o ver the 11 years of the study (p < 0.0001). BCT was more frequently used fo r smaller tumors (< 2 cm), with an odds ratio of 2.46 (2.20-2.76, 95% CI). In 1996, 54% of women with T1 (< 2 cm) tumors were treated with BCT. Women treated with BCT were nearly the same age as those undergoing modified radi cal mastectomy (55.5 years versus 56.8 years, p < 0.0001). BCT was used at a slightly greater rate in medical centers than in community hospitals (31% versus 28%, p < 0.0001). Use of BCT varied among geographic regions from a low of 24% in the southwestern USA to a peak of 36% in the Northeast and 4 0% in hospitals outside of the continental United States (p < 0.0001). Loca l availability of radiation therapy did not influence choice of treatment. CONCLUSIONS: The use of BCT to treat early stage invasive breast carcinoma in the Department of Defense Healthcare System is increasing. But BCT is us ed less often to treat larger tumors. Regional differences in the use of BC T persist, even after controlling for other factors. Patient age and type o f hospital (community versus academic center) appear to exert little influe nce on the choice of treatment. Local availability of radiation therapy did not seem to influence the choice of treatment. Our data suggest that effor ts to promote the use of BCT should target the central and southwestern USA . Use of BCT should also be emphasized for women with larger tumors (> 2 cm ). (J Am Coll Surg 2001;192:293-297. (C) 2001 by the American College of Su rgeons).